Few would argue that delivering the best possible care is the overarching goal of virtually every healthcare facility in this country; and yet, providers have attained this objective with varying degrees of success. While striving for quality, they recognize that the current healthcare delivery system does not always facilitate optimal outcomes for every patient across the continuum of care.

The emergence of pay-for-performance (P4P) initiatives has shone a light on the flaws and fissures in healthcare delivery. The P4P agenda is undeniably founded on a commitment to improving patient care outcomes. And, because of the potential impact on the bottom line, the movement has invigorated discussions about quality at the highest levels of healthcare organizations.

C-suite executives recognize that improved outcomes can be achieved only if the right clinician has the right information — at the right time — to make the right decision for the right patient. This means re-evaluating how healthcare organizations manage information. Presently, patient data often reside in silos, with each independent provider claiming proprietary access to his or her own records. But to optimize quality and care, this information must be shared between primary care providers and specialists, ambulatory settings and hospitals, as well as long-term and acute care facilities.

Falling Short of Potential

   But therein lies the rub. Healthcare organizations have invested precious resources, both human and financial, in information technology (IT) at an aggressive pace throughout the past 10 years or so. Yet sole-source systems have not delivered the results leaders anticipated, and have left them decidedly disillusioned with IT solutions that have over-promised and under-delivered.

Physicians and clinical staff likewise have grown frustrated. The conversion from paper to electronic systems has demanded many different types of investments on their part; changing entrenched personal work styles, adapting to dramatic modifications in institutional workflow, and learning new skill sets associated with computer software and hardware are a few examples. However, despite their efforts, clinicians have yet to enjoy the benefits they were assured would ensue.

In the face of these setbacks and obstacles, healthcare organizations have nevertheless continued to implement IT systems for a number of reasons: They recognize, at some level, the value IT offers — even if this potential has not yet been achieved. Furthermore, they concede that this is the “information age” and that all industries are bowing to a greater reliance on technology. And, they realize that as a greater proportion of their income derives from P4P, the need to comply with IT and reporting requirements will only grow.

Accelerating IT Value

To overcome these deficiencies and achieve the long-anticipated outcomes promised by the IT revolution, many healthcare organizations are adopting interoperability platforms to improve performance, quality and outcomes. These platforms facilitate health information exchange between disparate technology systems. The most advanced approach in interoperability, in fact,
allows two systems to not only share information, but also enables the receiving system to understand and make use of the incoming data while maintaining the original “meaning” of that data. Ultimately, an interoperability platform can deliver an integrated view of a patient’s medical history to any clinician at the time of care — regardless of where the information originates within disparate technology systems.

Among the potential gains a healthcare enterprise can realize through this capability is improved efficiency. One of the most substantial causes of waste in the healthcare system is tracking down information and supplies crucial to the care of patients.

At University of Pittsburgh Medical Center (UPMC), for instance, quality professionals have observed nurses preparing patients for surgery. The range of time nurses spent looking for information was from one to 41 minutes, while the range of time they waited to receive necessary information was between five minutes to as much as 20 hours. Despite their efforts, about 30 percent of patients were not adequately prepared for their procedure on the day of surgery.

Implementation of an interoperability platform, on the other hand, enables clinicians of healthcare organizations to make data immediately accessible, even if it is generated by or stored in unrelated systems. This functionality can have a significant and positive impact in a number of areas, including pre-procedural testing, access to and delivery of old medical records, diagnostic imaging screening, and completing accurate admission assessments.

Further Potential

Other gains can be measured to improvements of clinical outcomes. There can be no question that the quality agenda is growing at an explosive rate. The Centers for Medicare & Medicaid Services (CMS) has implemented 27 quality measures already, with plans to expand the number by 43 in 2009 and by more than 100 in 2010. CMS also recently increased its list of selected hospital-acquired conditions from eight to 11.

Many healthcare organizations have reached the conclusion that manual extraction and reporting is virtually impossible, and that discrete electronic medical record systems offer only an incremental improvement.

Alternatively, best-of-class interoperability solutions offer open-source access to data throughout the care continuum — simplifying reporting, increasing successful participation in P4P and improving care. Because a longitudinal patient record is easy to obtain, healthcare organizations can shift focus from isolated chart review to genuine analysis and trending. Interoperability permits the organization to thoughtfully question results and outcomes, and consequently investigate patient care issues. This microscope can likewise be focused on the entire enterprise, because leadership can generate a snapshot of select clinical outcomes within a patient population and determine if problems exist that require attention.

A classic example can be found in tracking surgical site infections — an issue of growing importance at healthcare organizations throughout our country today, with more than 30 states mandating infection rate monitoring. Previously at UPMC, an infection control nurse was tasked with contacting the surgical team about incidence of infection and how cases were treated. Data collection was totally dependent on whether the surgeon responded. Interoperability now allows the nurse to independently mine data residing in the system, review information on patients who had surgery and check if they were subsequently prescribed antibiotics. In addition, through the use of an interoperability platform, reports detailing the number of cases, types of infections and methods of treatment can be generated automatically.

Additional Considerations

The patient-centered nature of the technology is also an asset. Virtually all care providers recognize the critical need to ensure medical records and information management processes are patient-centric. No longer do patients remain in the same geographic area, being treated by the same providers from cradle to grave. High mobility has made continuous healthcare in one location a rare luxury, and has engendered an environment of waste due to the rework that must occur when patients move from one provider location to another. Interoperability offers the opportunity to reduce this waste in a number of ways, such as making use of emerging functionality to give patients personal access to their records (e.g., PHRs). Another is the option of developing encrypted log-in codes so new or remote providers can have temporary Internet access to longitudinal records.

This level of access helps eliminate unnecessary testing and speeds development of treatment plans because providers have a comprehensive view of the patient’s status from virtually any location. Perhaps most importantly, this approach engages patients so they are more invested in their own care. UPMC is in the process of determining how to provide this personal access to patients, with the goal of having it available in early 2009.

Population management and outcomes can be enhanced as well. Increasingly, providers are directing their attention to enterprise clinical decision support systems (ECDSS) that integrate clinical data across the continuum. The implementation of an interoperability platform provides a framework that enables continuous monitoring of patient populations for defined clinical events. Providers are alerted to changes in the patient’s condition or departures from a prescribed care plan, and can then intervene to improve health and outcomes.

Also, consider patients with multiple co-morbidities and non-healing wounds. It is widely acknowledged that these individuals consume significant resources, experiencing frequent re-admissions and failed plans of care. When ECDSS and interoperability platforms are available, any provider can view the complete record of all care and treatment supplied to the patient. Clinical photos of patient wounds can be embedded and retrieved so that all clinicians can monitor progress.

Because care is coordinated — and consistent — wounds heal more quickly (sometimes in half the time) and overall costs are significantly reduced.

Good Business Sense

Interoperability and better data management can only improve clinical outcomes, yet a strong business case can likewise be made for this approach, with potential for gains in three specific areas: First, cost savings: Healthcare organizations can eliminate duplicative testing on fixed reimbursement cases, for instance, and reduce administrative FTEs by automating previously manual processes. Second, control investment in IT: The availability of an interoperability solution may prompt a healthcare organization to revise its entire IT strategy. Rather than trying to convert to a single platform, leadership can utilize interoperability to integrate legacy systems. And third, strengthen the referral base and revenue source. Likewise, organizations potentially can improve physician loyalty by providing access to patient data in their offices via the Internet.

Implementation of an interoperability platform, on the other hand, enables clinicians of healthcare organizations to make data immediately accessible, even if it is generated by or stored in unrelated systems.

Healthcare organizations can accomplish much if the right data is placed in the right hands at the right time. Providers are empowered to make better clinical decisions and institute the most effective care plans when this data is accessible, while patients receive optimal and timely treatment, likely resulting in better outcomes.

Healthcare organizations improve workflow with this technology, cut costs and maximize access to revenue opportunities. With an interoperability platform in place, they are much better equipped to accelerate clinician access to the vital information that will allow the entire organization to capitalize on these gains and hasten the return on their technology investments.

October 2008